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Coronavirus disease (COVID-19), a global pandemic affecting the whole world and taking the lives of millions. The majority of fatalities occur in the elderly specially in the presence of chronic diseases such as diabetes mellitus (DM), hypertension, obesity, cardiovascular disease, chronic kidney disease and cancer.
Knowing about the family of coronaviruses is that they are the cause of a variety of well-known diseases affecting humans, ranging from common cold to the Middle East Respiratory Syndrome (MERS) and Acute Severe Respiratory Syndrome (SARS), and now the COVID-19 as a new problematic family member.
Regarding DM as a knowing old health problem, it has been found that we can use it in predicting the prognosis of the COVID-19 as admission to intensive care unit, invasive ventilation or even death.
Previous studies confirmed that uncontrolled DM can badly affects innate immunity which considered as the first line of defence mechanism against COVID-19 infection.
In addition, DM has a pro-inflammatory effect through exaggeration of cytokine response which appears clearly through higher results of serum levels of interleukin-6 (IL-6), C-reactive protein and ferritin, this suggests that people with DM are more venerable to cytokine storm which leads to Acute Respiratory Distress Syndrome (ARDS), shock and rapid deterioration of the case.
On the other hand, on looking to previous studies and data collected about the prior SARS outbreak in 2003, which suggested that COVID-19 can lead to worsening of glycemic control in known diabetic patients and above that caused by the stressful nature of a critical illness.
In addition, COVID-19 can lead to increasing insulin resistance specially in patients with type II DM. Also, the medications used in the management of COVID-19 having an indirect role on worsening of blood sugar levels also should be taken in our consideration, Corticosteroids as an example, used in the management of patients having ARDS or sepsis can lead to changes in their glycemic profile.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| COVID-19 with DM | All patients will be screened for diabetes according to history and blood glucose measurements as well as HbA1C. Accordingly, the patients will be divided into two groups, diabetic and non-diabetic group. |
| |
| COVID-19 without DM | All patients will be screened for diabetes according to history and blood glucose measurements as well as HbA1C. Accordingly, the patients will be divided into two groups, diabetic and non-diabetic group. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Reverse transcription polymerase chain reaction (RT-PCR) | Diagnostic Test | For SARS Corona Virus 2 (COV2) confirmation |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mortality rates | mortality rate among diabetic and non diabetic COVID-19 patients | up to 1 year |
| Hospital stays | for how long patients admitted to hospital | up to 1 year |
| Need for ICU admission | who will need ICU admission during patient hospitalization | up to 1 year |
| Need for ventilatory support | who will need for ventilatory support (Non-Invasive ventilation (NIV), High Flow Nasal Cannula (HFNC) and Invasive Mechanical Ventilation (IMV). | up to 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Glycemic control | monitoring of glycemic control among patient groups | up to 1 year |
| Newly onset DM will appear among non-diabetic patients | who will develop DM among non-diabetic group |
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Inclusion Criteria:
Exclusion Criteria:
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All patients admitted to Assiut University Hospital from the 1st of Oct. 2021 to 1st of Oct. 2022 with confirmed COVID-19 infection, will be included, based on WHO case definitions of COVID-19 All patients will be surveyed and scored by the criteria of COVID-19 severity index, and accordingly categorized into low, moderate, high and critically ill cases All patients will be screened for DM according to history and blood glucose measurements as well as HbA1C.
Accordingly, the patients will be divided into two groups, diabetic and non-diabetic group.
Diabetic patients' group will be categorized according to their glycemic control by using their glycated hemoglobin (HBA1C) used to determine their past two to three-month glycemic control, into good control, fair control and poor control
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Raafat T. Ebrahem, MD | Contact | +201006155517 | raafatelsokkary1@gmail.com | |
| Ahmed M. Azozz, MD | Contact | +201002163907 | ahmedmetwally@aun.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| Martina S. Lamey Eskander, MBBCH. | Assiut University | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32109013 | Result | Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28. | |
| 32171076 |
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|
| Glycated haemoglobin (HbA1C) | Diagnostic Test | Diabetic patients' group will be categorized according to their glycemic control by using their glycated haemoglobin (HBA1C) into good control, fair control and poor control |
|
|
| High Resolution Computed Tomography (HRCT) | Radiation | with the coronavirus disease 2019 Reporting and Data System (CO-RADS) classification grade 5 for SARS COV2 confirmation |
|
|
| Routine Laboratory investigations | Diagnostic Test |
|
|
| Random Blood Sugar (RBS) | Diagnostic Test | Blood Sugar will be measured before each meal and before bed time during hospitalization. |
|
| up to 1 year |
| Acute complications of diabetes | as hypoglycaemia, diabetic ketoacidosis and hyperosmolar nonketotic coma | up to 1 year |
| Exacerbation of chronic complications of diabetes | as diabetic retinopathy, nephropathy and neuropathy | up to 1 year |
| Changes of diabetes management plan | who will be shifted from oral to insulin therapy and who will be changed of their insulin regimen or introduction form from subcutaneous to intravenous infusion | up to 1 year |
| Incidence of other complications | as hypertension renal and liver diseases | up to 1 year |
| Result |
| Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11. |
| 32250385 | Result | Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G, Latronico N, Lorini L, Merler S, Natalini G, Piatti A, Ranieri MV, Scandroglio AM, Storti E, Cecconi M, Pesenti A; COVID-19 Lombardy ICU Network. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020 Apr 28;323(16):1574-1581. doi: 10.1001/jama.2020.5394. |
| 32217650 | Result | Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Liu XQ, Chen RC, Tang CL, Wang T, Ou CQ, Li L, Chen PY, Sang L, Wang W, Li JF, Li CC, Ou LM, Cheng B, Xiong S, Ni ZY, Xiang J, Hu Y, Liu L, Shan H, Lei CL, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Cheng LL, Ye F, Li SY, Zheng JP, Zhang NF, Zhong NS, He JX; China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020 May 14;55(5):2000547. doi: 10.1183/13993003.00547-2020. Print 2020 May. |
| 26897277 | Result | Jafar N, Edriss H, Nugent K. The Effect of Short-Term Hyperglycemia on the Innate Immune System. Am J Med Sci. 2016 Feb;351(2):201-11. doi: 10.1016/j.amjms.2015.11.011. |
| 32233013 | Result | Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, Qin R, Wang H, Shen Y, Du K, Zhao L, Fan H, Luo S, Hu D. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020 Oct;36(7):e3319. doi: 10.1002/dmrr.3319. Epub 2020 Apr 7. |
| 32281287 | Result | Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev. 2020 Jun;21(6):e13034. doi: 10.1111/obr.13034. Epub 2020 Apr 13. No abstract available. |
| 33478781 | Result | Huespe I, Carboni Bisso I, Di Stefano S, Terrasa S, Gemelli NA, Las Heras M. COVID-19 Severity Index: A predictive score for hospitalized patients. Med Intensiva (Engl Ed). 2020 Dec 29;46(2):98-101. doi: 10.1016/j.medin.2020.12.001. Online ahead of print. No abstract available. |
| 32339082 | Result | Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, Geurts B, Gietema H, Krdzalic J, Schaefer-Prokop C, van Ginneken B, Brink M; COVID-19 Standardized Reporting Working Group of the Dutch Radiological Society. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020 Aug;296(2):E97-E104. doi: 10.1148/radiol.2020201473. Epub 2020 Apr 27. |
| 33584062 | Result | Moftakhar L, Moftakhar P, Piraee E, Ghaem H, Valipour A, Azarbakhsh H. Epidemiological characteristics and outcomes of COVID-19 in diabetic versus non-diabetic patients. Int J Diabetes Dev Ctries. 2021 Jul;41(3):383-388. doi: 10.1007/s13410-021-00930-y. Epub 2021 Feb 9. |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D014777 | Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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